Pulmonary rehabilitation (PR) is a key intervention for chronic obstructive pulmonary disease (COPD), yet its availability in XXX primary care remains limited, creating a gap between guideline recommendations and real-world care. The EXpiRA+ programme was developed and implemented in four primary healthcare units to improve exercise tolerance, functional capacity, symptoms, and psychosocial wellbeing in COPD patients.To describe changes in functional performance, dyspnea, quality of life, psychological status and multidimensional prognosis among participants in the EXpiRA+ programme.A longitudinal observational study was conducted between January 2022 and April 2025, including 18 adults with COPD. The intervention comprised an 8-week multimodal PR programme, integrating structured exercise training and educational sessions. Assessments were performed at baseline, 8 weeks and 6 months. Outcomes included 6-Minute Walk Test (6MWT), 1-Minute Sit-to-Stand Test (1-STS), London Chest Activity of Daily Living (LCADL), COPD Assessment Test (CAT), modified Medical Research Council dyspnoea scale (mMRC), Hospital Anxiety and Depression Scale (HADS), and the BODE Index. Medians (P25–P75) were calculated. Wilcoxon signed-rank and Friedman tests were used.Significant improvements from baseline to 8 weeks were observed in exercise capacity [6MWT: 380 (297-525); 463 (390-525); p=0.012; 1-STS: 16.5 (11.5-24); 27 (20.5-39); p=0.005)], symptoms [CAT: 17 (9.5-24); 5 (3.5-19); p=0.012; mMRC: 2 (1-2); 1 (1-2); p=0.002)], and psychological well-being [HADS: 12.5 (9-16); 8 (4.5-12); p=0.018)]. At 6 months, improvements were largely retained, although not all remained statistically significant [6MWT: 380 (297-525); 480 (420-551); p=0.130; 1-STS: 16.5 (11.5-24); 31 (15-42); p=0.126; CAT: 17 (9.5-24); 6 (4-10); p=0.022; mMRC: 2 (1-2); 1 (0-2); p=0.011); HADS: 12.5 (9-16); 4 (3.5-9); p=0.017)]. Non-significant trends were observed for LCADL and the BODE Index. Friedman tests indicated significant global changes across time for 1-STS, CAT, mMRC, and HADS.EXpiRA+ produced clinically meaningful gains in functional performance, dyspnea, health status and psychological wellbeing, with substantial retention at 6 months. The programme demonstrates operational feasibility and potential reproducibility across multiple primary care units.EXpiRA+ was associated with sustained improvements across several clinical domains and represents a feasible PR model deliverable in XXX primary care.

Bronchial asthma is a chronic respiratory disease requiring regular assessment of disease control and long-term follow-up. In primary care, limited access to frequent visits and high workload may negatively affect adherence, self-management, and timely adjustment of therapy. Digital remote monitoring tools may support continuity of care and patient engagement between visits.The objective of this study was to evaluate the effect of a digital remote monitoring program on asthma control, lung function, and medication use over a six-month period in a primary care setting, compared with usual carA prospective observational study included 82 adult patients with bronchial asthma, divided into a remote monitoring group (n = 40) and a usual care group (n = 42). All participants underwent baseline clinical assessment. Patients in the remote monitoring group received structured asthma self-management education and peak flow meters for home monitoring. Follow-up was supported by a digital remote monitoring system that automated monthly reminders and collected patient-reported outcomes via mobile messaging. Asthma control was assessed using the Asthma Control Questionnaire (ACQ-5). Peak expiratory flow (PEF) and information on asthma medication use were recorded during the six-month follow-up period. Appropriate parametric and non-parametric statistical tests were applied.At baseline, the mean ACQ-5 score was 2.3, indicating poor asthma control in the majority of patients. After six months of follow-up, patients in the remote monitoring group demonstrated a significant improvement in asthma control. The mean ACQ-5 score decreased from 2.3 to 1.1 (p < 0.001), reflecting a clinically meaningful improvement. Lung function also improved during the observation period, with mean PEF increasing from 330 L/min to 371 L/minThe improvement in asthma control occurred without major changes in pharmacotherapy, suggesting that enhanced monitoring, patient education, and self-management played a key role.Digital remote monitoring was associated with improved asthma control over six months in primary care. Automated follow-up and home peak flow monitoring supported self-management without increasing medication burden.

Digital tools may support healthcare professionals in providing guideline-directed management for patients with allergic rhinitis (AR).This study aimed to develop and implement the Respiratory Allergy Optimiser (RAO), a digital decision support tool based on treatment recommendations from existing clinical AR guidelines, and to evaluate its clinical effectiveness in reducing AR symptom severity.The AERO study was an interventional study conducted in 11 general practices (GPs) across the Netherlands (August-November 2025). Adult patients (≥18 years) with a diagnosis of allergic rhinitis and/or allergic conjunctivitis (AC) and/or prescribed AR medication within the previous three years, were included. The RAO was used during a GP consultation, during which AR/C symptom severity and management were assessed using a visual analogue scale (VAS)(0-100mm, complaints past 7 days) and questions. Two weeks later, patients completed a follow-up survey including the VAS. User experience data were collected from healthcare professionals and patients.In total, 104 patients with rhinitis (mean age 49.0 years (SD 16.5), 61% female) were included. Mean VAS score was 35.1 mm (SD 25.6) at baseline and 35.8 (SD 25.4) at follow-up. For 30% of patients, the advice was to continue the current treatment, while for 50% the advice was to step up treatment. In 15 (14.4%) patients, step up plus allergy immunotherapy was advised. In patients with uncontrolled rhinitis (VAS>50mm)(n=33), VAS scores significantly decreased two weeks after the study consultation with the RAO (65.7 mm (SD 9.7) vs 47.7 (SD 22.0); p=0.003).In 70% of patients, the RAO suggested changes toward more guideline-directed treatment. Among patients with uncontrolled rhinitis, use of the RAO during consultation was associated with reduced symptom severity after two weeks. User experience was generally positive among patients and healthcare professionals, identifying opportunities for further improvement.In Dutch general practice, the Respiratory Allergy Optimiser supported identification of opportunities to improve allergic rhinitis management, particularly by addressing poor disease control.

Chronic obstructive pulmonary disease (COPD) remains one of the least diagnosed and undertreated chronic conditions globally and nationally. In 2024, a comprehensive clinical audit was conducted across nine primary care teams to evaluate the quality of COPD management, identify system gaps, and compare current practice with evidence-based national protocols updated in 2023. The audit aimed to assess diagnostic accuracy, symptom monitoring, appropriateness of treatment, prevention activities, and follow-up patterns.A full audit of all 180 COPD cases recorded in 2024 was undertaken. Data were retrospectively extracted from electronic medical records using predefined indicators reflecting structure, process, and outcomes of care. Analysis covered demographics, smoking status, spirometry, GOLD-based severity assessment, symptoms (CAT, mMRC), treatment alignment, vaccination, referrals, and hospitalization. Strengths of the audit included comprehensive case inclusion and multidisciplinary review; limitations included inconsistent documentation, limited availability of spirometry, and variable data completeness across teams.Findings revealed significant underdiagnosis (prevalence 0.9%), limited symptom assessment (CAT/mMRC documented in ~11%), low use of spirometry (18%), inconsistent GOLD classification, and suboptimal treatment alignment (34%). Preventive care (especially influenza and pneumococcal vaccination) remained markedly low. Referral pathways and documentation practices varied widely, suggesting the need for standardized workflows, enhanced training, and improved data quality systems. Strengthening nurse-led monitoring, integrating mandatory EMR fields, improving spirometry access, and developing team-based follow-up processes could meaningfully enhance COPD care.The audit demonstrated substantial variability across teams, highlighting gaps in diagnostic and monitoring practices, in continuity of care, prevention, and documentation. These findings indicate opportunities for structured quality improvement supported by protocols, supervision, and targeted training.The 2024 audit underscored the need for systematic improvements in diagnosis, monitoring, treatment alignment, and preventive care. Enhancing structured workflows and strengthening team-based practice can significantly improve patient outcomes and align primary care with international COPD standards.

Chronic Obstructive Pulmonary Disease (COPD) is a progressive condition that significantly reduces quality of life and is frequently accompanied by psychiatric comorbidities, particularly depression. In primary care settings, unrecognized depressive symptoms may worsen disease perception, treatment adherence, and overall outcomes. Understanding the association between COPD severity and depression, and the sociodemographic factors influencing this relationship, is essential for improving patient-centered management strategies in family medicine.To evaluate the relationship between COPD severity and depression among adult COPD patients presenting to family medicine outpatient clinics, and to identify sociodemographic variables associated with depressive symptoms.This descriptive cross-sectional study was conducted between June 1 and December 1, 2024, in the Family Medicine outpatient clinics of a tertiary training and research hospital. The study included 125 adult patients diagnosed with COPD. Data were collected using a 10-item sociodemographic questionnaire, the 8-item COPD Assessment Test (CAT), and the 21-item Beck Depression Inventory (BDI). A CAT score ≥21 was accepted as indicating high COPD severity, and a BDI score ≥17 was considered indicative of depression. Data were analyzed using IBM SPSS 20, with statistical significance set at p0.05). Both CAT and BDI scores increased with age, and higher CAT scores were significantly associated with higher BDI scores (p<0.05). Regular COPD follow-up was not significantly associated with depression.Findings indicate that depressive symptoms are common among COPD patients and appear to increase with disease severity. Sociodemographic factors showed no significant impact, suggesting that clinical parameters may play a more dominant role.Depression is more prevalent in COPD patients compared with the general population, and its likelihood increases with greater disease severity. Routine use of the CAT in primary care may facilitate early recognition of depressive symptoms. Integrating psychosocial assessment into regular follow-up could improve quality of life and support comprehensive COPD management.